How does health insurance work?

If you have health insurance you can arrange to receive fast private treatment in a few easy steps:

If you suspect something is wrong with your health, visit your GP and tell them that you have private health insurance.

If you need treatment, your GP will be able to immediately refer you to a leading specialist and private hospital of your choice.

You must inform your insurance company that you want to make a claim on your policy and confirm your cover.

When your health insurance company provide approval your GP will book your appointment with the specialist. This will be paid for by your insurer.

Health insurance will not cover medical emergencies. If you require emergency treatment you will need to visit Accident and Emergency on the NHS as normal.

However, once your health is stabilised your health insurance will cover your continued private treatment.

What types of health insurance policies are available?

Budget. Budget policies are the cheapest form of health insurance but they will normally only provide cover for in-patient and day-patient treatment with limits on the amount you can claim.

Mid-range. Most mid-range health insurance policies cover full in-patient and day-patient treatment and selected outpatient treatments. Mid-range policies are a good option if you want the benefits of private healthcare at an affordable price.

Comprehensive. Comprehensive health insurance policies are the most expensive option but provide full in-patient, day-patient and outpatient cover, with benefits like psychiatric cover and complementary therapy included.

However, not all insurers use these terms to classify their health insurance products, which is why uSwitch’s comparison service shows you the full details of every policy online to help you compare them.

Can I switch to another policy without losing cover?

Yes, you can. Switch/CPME (continuing personal medical exclusion) underwriting allows you to switch policies without losing cover for conditions that arose whilst you were covered on your original policy. You can compare ‘switch policies’ online with uSwitch or by calling 0800 862 0360*.

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What hospitals can I use with my health insurance cover?

Every health insurance policy comes with a list of approved hospitals which may vary, depending on how much you pay. For example, not all policies will cover premium hospitals in London. Make sure you are happy with your hospital list before buying your health insurance policy, especially if there is a particular private hospital you would want to use.

What factors will affect the cost of my health insurance?

Health insurance premiums are determined by different factors that can increase or decrease the monthly cost. Naturally your current health and medical history is an important factor for insurers and some providers will offer discounted premiums and cashback if you exercise regularly and eat healthily.

If you smoke you may experience higher premiums than non-smokers and your age will also impact the cost of your policy.

Can I make my health insurance premiums any cheaper?

There are a range of discount schemes which can be applied to your health insurance policy to make it more affordable without sacrificing on the cover you need. These include:

Six week option: If the NHS is able to provide treatment within six weeks, you will be treated on the NHS. However, if the NHS cannot guarantee treatment within six weeks you can use your health insurance policy to be treated straight away.

Excess: You can volunteer to pay the first part of any claim, which will be agreed when the policy is purchased. The higher the excess on your policy, the lower your premiums.

Co-payment: You can volunteer to pay a percentage of any claim which will reduce your premium.

Reduced hospital list: Choosing this option means you will not pay for hospitals you do not need.

You can usually apply as many or as few of these schemes to your policy as you like to reduce the premiums.

What will health insurance not cover?

Health insurance is not designed to cover emergency medical treatment but it will cover your treatment once your condition has stabilised.

Typically health insurance will not provide cover for any of the following; pregnancy, fertility treatment, cosmetic treatment, gender reassignment or any other voluntary medical treatment.

Health insurance does not usually cover the treatment of chronic conditions but it may provide healthcare to stabilise a chronic condition if there is a serious flare-up of the condition.

Can I cover pre-existing conditions?

Health insurance is designed to cover conditions that you develop after taking out your policy. However, the type of underwriting you choose will determine whether your pre-existing conditions are covered in the future. There are three main types of underwriting:

Moratorium: Moratorium policies will normally exclude cover for any condition you have experienced in the previous 5 years. However, if you receive no symptoms, treatment or advice for that condition in the first two years of the policy you will regain cover for it.

Full medical underwriting (FMU): FMU policies require you to provide your full medical history on application. Usually your insurer will exclude cover for pre-existing conditions, but you will be made aware of these exclusions before you commit to buying the policy.

Switch: Switch underwriting allows you to change insurers without losing cover for conditions you have suffered since taking out your old policy.
Will my health insurance payments change?

Your health insurance premiums may increase as you get older as you are more likely to claim on your policy. The level of increase will vary depending on your insurer and policy. It is worth reviewing your policy every year to make sure you are getting the right level of cover for the lowest price.

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